The diaphanous membrane between sane and insane

Yesterday, I finished reading a book called "Weekends at Bellevue" by Julie Holland, which chronicles nine years in the live of a psychiatric ER doctor in New York City. It was a tremendously absorbing read, and it gave me a lot of insight into what might be going on in the minds of the people who have treated me in crisis and tried to talk me down from the rafters, as I insisted that the Saltines and cranberry juice would make me fat and that I really didn't need sleep/food/water.

But it was a passage on the last two pages of the text that really struck me:

There is a diaphanous membrane between sane and insane. It is the flimsiest of barriers, and because any one of us can break through at any given time, it scares all of us. We all lie somewhere on the spectrum, and our position can shift gradually or suddenly. There is no predicting which of us will be afflicted with dementia or schizophrenia, who will become incapacitated with depression or panic attacks, or become suicidal, manic, or addicted. None of these states of mind are uncommon, and all of us have friends and family who are suffering with some degree of psychiatric illness. Many of us should be grateful for our relative mental health.

The reality is this: All of us, to some degree, are mentally ill. We get paranoid, anxious, depressed, and insomniac. We alternate between delusions of grandeur and crippling self-doubt, we suffer from paralyzing fears and embarrassing neuroses. We all have compulsions to do things we know we shouldn't, and there are millions of us with addictions, whether to gambling, drinking, dieting, or playing Second Life. Every one of us has psychiatric symptoms, many of them serious enough to warrant attention, even if they are not incapacitating. But few of us are willing to let on that we are suffering. This secrecy and shame compounds our avoidance of those who have been officially diagnosed as mentally ill...

We avoid dealing with psychiatric patients because we hate to see things in others that we don't want to see in ourselves: weakness, need, despair, aggression. Our experiences with the psychiatrically ill often fill us with dread; they confront us with our own terror or reaching a catastrophically altered state from which there is no return. We should be compassionate to those who stumble out of our lockstep. Yet in our culture, the mentally ill are demonized and shunned. They are ostracized and marginalized as a by-product of our primal fear of going crazy ourselves. It is the nightmare of our own "shadow self," as Jung called it, that allows us to treat others so harshly.

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Cathy (UK) said...

Interesting post... I dislike the stigma around mental illness - and the 'pigeon-holing' of people into categories of 'normal' and 'abnormal'. For example, reading the DSM IV (and proposed changes to DSM V) leaves me feeling saddened.

I have been given many diagnoses through my life. As a child, pre-anorexia, I was described as 'neurotic' due to my marked obsessive-compulsive traits, social anxiety and sometimes crippling OCD. And then I became anorexic - on top of all the other 'neuroses'.

It is not so simple to devise two distinct categories of people: 'sane' and 'insane'. Our traits lie on a normal distribution, with all individuals exhibiting a greater or lesser degree of 'neuroses', depending upon the stresses in their lives and their capacity to cope.

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esqueci a ana (ex-ana) said...

The Allen Frances' article about 'normality' is also very interesting

Title:It's not too late to save 'normal'
Psychiatry's latest DSM goes too far in creating new mental disorders.

Harriet said...

Great post, Carrie. And so true. It's something I've been thinking about for a long time.

Anonymous said...

Off to buy the book,

Anonymous said...

Wow, I will read this. I am a psychiatric nurse and the quote you put up is my philosophy too. I really haven't heard anyone else (besides what I say in my head) feel that way about mental illness, and how we ALL have it, just those that are "mentally ill" are just severe cases of disruption.

Thanks for the post!

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I'm a science writer, a jewelry design artist, a bookworm, a complete geek, and mom to a wonderful kitty. I am also recovering from a decade-plus battle with anorexia nervosa. I believe that complete recovery is possible, and that the first step along that path is full nutrition.

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